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1.
Article in Chinese | WPRIM | ID: wpr-1029747

ABSTRACT

Objective:To investigate the influencing factors of increased tube bleeding within 24 h after coronary artery bypass grafting(CABG) and its correlation with perioperative complications.Methods:This study was a prospective observational study. The patients with CABG surgery were enrolled in Beijing Anzhen Hospital affiliated to Capital Medical University from May 2018 to December 2021. The age, sex, complications, blood tests and other clinical data of outpatients were collected. Left ventricular ejection fraction(EF) and left ventricular enddiastolic diameter(LVED) were detected by echocardiography. MGF and PI of grafts were recorded during CABG. Perioperative troponin Ⅰ, blood clotting pentathlon, all-cause death, perioperative myocardial fraction, atrial fibrillation and stroke were collected. According to the tube bleeding within 24 h after operation, the patients were divided into increased group(tube bleeding>1 000 ml) and normal group(tube bleeding≤1 000 ml). The preoperative baseline data, intraoperative indexes and perioperative complications were compared between the two groups. Logistic regression, Spearman and linear regression models were used to analyze the correlation between tube bleeding within 24 h and clinical data.Results:304 patients underwent CABG were enrolled. There were 185 cases(60.9%) in the increased group and 119 cases(39.1%) in the normal group. After adjusting for age, sex and BMI, multivariate logistic regression analysis showed that male( OR=2.40, 95% CI: 1.38-4.18, P=0.002), history of stroke( OR=2.37, 95% CI: 1.07-5.26, P=0.034), and history of myocardial infarction( OR=1.81, 95% CI: 1.13-2.91, P=0.014) could significantly increase the risk of tube bleeding within 24 h after surgery. The average blood flow of the anterior descending branch( OR=0.99, 95% CI: 0.99-1.00, P=0.022) and the circumflex branch( OR=0.99, 95% CI: 0.98-1.00, P=0.003) during the operation was significantly negatively correlated with the increase of tube bleeding within 24 h after surgery, while the PI of anterior descending branch( OR=1.81, 95% CI: 1.26-2.61, P=0.001), circumflex branch( OR=1.45, 95% CI: 1.07-1.97, P=0.017), right coronary artery( OR=1.84, 95% CI: 1.29-2.62, P=0.001) were positively correlated with the increase of tube bleeding within 24 h after operation. In addition, prothrombin time significantly increased the risk of increased tube bleeding within 24 h after surgery( OR=1.16, 95% CI: 1.03-1.30, P=0.018). Linear regression analysis showed that there was a significant positive linear correlation between ICU time and tube bleeding within 24 h after surgery( OR=0.17, 95% CI: 0.96-4.58, P=0.003), and a significant negative linear correlation between postoperative ejection fraction and tube bleeding within 24 h( OR=-0.25, 95% CI: -33.18--13.07, P<0.001). Conclusion:Increased tube bleeding within 24 h after CABG is most common in males and patients with a history of cardiovascular and cerebrovascular infarction. Better graft hemodynamic parameters can reduce the tube bleeding within 24 h after the operation, further improve cardiac function and reduce ICU time.

2.
Article in Japanese | WPRIM | ID: wpr-1040188

ABSTRACT

Cardiovascular syphilis and syphilitic aortitis, known as late complications of syphilis, are rarely encountered in clinical practice. However, an increase in the number of syphilis cases has been reported in recent years, during which it has also manifested as a complicating infection in those with HIV. A 66-year-old man, who had no previous laboratory findings of syphilis and no subjective symptoms, presented with a complaint of dyspnea. A diagnosis of cardiovascular syphilis was made based on a positive syphilis serological reaction in the preoperative examination for surgical treatment of a left coronary artery ostium obstruction and aortic regurgitation. Three weeks after treatment with amoxicillin, the patient underwent an aortic valve replacement with a bioprosthetic valve and coronary artery bypass surgery. The aortic wall was yellowish with marked circumferential wall thickening and erosion of the intima. The area where the left coronary artery originates was occluded by intimal thickening and revealed only a dimple-like scar. The aortic valve was tricuspidate with thickening and a shortening of the left coronary leaflet. Pathology showed inflammatory cell infiltration of the aortic tunica media, consistent with syphilitic vasculitis. The postoperative course was uneventful and the patient continues to be treated with antibiotics on an outpatient basis.

3.
Braz. J. Anesth. (Impr.) ; 73(6): 775-781, Nov.Dec. 2023. tab, graf
Article in English | LILACS | ID: biblio-1520388

ABSTRACT

Abstract Background: Early identification of patients at risk of AKI after cardiac surgery is of critical importance for optimizing perioperative management and improving outcomes. This study aimed to identify the association between preoperative myoglobin levels and postoperative acute kidney injury (AKI) in patients undergoing valve surgery or coronary artery bypass graft surgery (CABG) with cardiopulmonary bypass. Methods: This retrospective study included 293 patients aged over 17 years who underwent valve surgery or CABG with cardiopulmonary bypass. We excluded 87 patients as they met the exclusion criteria. Therefore, 206 patients were included in the final analysis. The patients' demographics as well as intraoperative and postoperative data were collected from electronic medical records. AKI was defined according to the Acute Kidney Injury Network classification system. Results: Of the 206 patients included in this study, 77 developed AKI. The patients who developed AKI were older, had a history of hypertension, underwent valve surgery with concomitant CABG, had lower preoperative hemoglobin levels, and experienced prolonged extracorporeal circulation (ECC) times. Multivariate logistic regression analysis revealed that preoperative myoglobin levels and ECC time were correlated with the development of AKI. A higher preoperative myoglobin level was an independent risk factor for the development of cardiac surgery-associated AKI. Conclusions: Higher preoperative myoglobin levels may enable physicians to identify patients at risk of developing AKI and optimize management accordingly.


Subject(s)
Humans , Aged , Acute Kidney Injury/etiology , Acute Kidney Injury/epidemiology , Cardiac Surgical Procedures/adverse effects , Postoperative Complications/etiology , Postoperative Complications/epidemiology , Cardiopulmonary Bypass/adverse effects , Risk Factors , Myoglobin
4.
Rev. argent. cardiol ; 91(5): 365-373, dic. 2023. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1550701

ABSTRACT

RESUMEN La decisión sobre la mejor estrategia de revascularización para los pacientes con enfermedad de múltiples vasos se ha tornado una tarea compleja a medida que la angioplastia coronaria ha mejorado sus resultados. En la siguiente revisión nos propusimos evaluar las variables que en nuestra experiencia definen el beneficio de una técnica sobre la otra, entendiendo que de esta manera la decisión del médico tratante se hace más sencilla y objetiva. Por otro lado, y festejando el saludable protagonismo que se le da al paciente, creemos que esta evaluación permite ofrecer argumentos sólidos para ayudarlo en la toma de la decisión.


ABSTRACT The decision on the best revascularization strategy for patients with multivessel disease has become a complex task as coronary angioplasty has improved its results. In the following review, we set out to evaluate the variables that, in our experience, define the benefit of one technique over the other, understanding that in this way the treating physician's decision will become simpler and more objective. On the other hand, and celebrating the healthy prominence given to patients, we believe that this evaluation allows solid arguments to help them in decision making.

5.
Article | IMSEAR | ID: sea-219276

ABSTRACT

Although rare, iatrogenic aortocoronary arteriovenous fistulae (ACAVF) occur when a coronary graft is mistakenly anastomosed to an epicardial vein rather than its intended arterial target. Patients may be asymptomatic, demonstrate angina, dyspnea, arrhythmias, syncope, or diminished exercise capacity, and may have wide pulse pressures with evidence of coronary steal. A thorough insight into the disordered anatomy is critical to safely manage a patient for redo cardiac surgery, especially when attempting to arrest the heart. We present a case for redo cardiac surgery of an iatrogenic ACAVF confirmed perioperatively with multiple modalities and its intraoperative management.

6.
Clinics ; Clinics;78: 100251, 2023. tab, graf
Article in English | LILACS-Express | LILACS | ID: biblio-1506030

ABSTRACT

Abstract Objective While Opioid Use Disorder (OUD) has been linked to inferior clinical outcomes, studies examining the clinical outcomes and readmission of OUD patients experiencing Acute Myocardial Infarction (AMI) remain lacking. The authors analyze the clinical and financial outcomes of OUD in a contemporary cohort of AMI hospitalizations. Methods All non-elective adult (≥ 18 years) hospitalizations for AMI were tabulated from the 2016‒2019 Nationwide Readmissions Database using relevant International Classification of Disease codes. Patients were grouped into OUD and non-OUD cohorts. Bivariate and regression analyses were performed to identify the independent association of OUD with outcomes after non-elective admission for AMI, as well as subsequent readmission. Results Of an estimated 3,318,257 hospitalizations for AMI meeting study criteria, 36,057 (1.1%) had a concomitant diagnosis of OUD. While OUD was not significantly associated with mortality, OUD patients experienced superior cardiovascular outcomes compared to non-OUD. However, OUD was linked to increased odds of non-cardiovascular complications, length of stay, costs, non-home discharge, and 30-day non-elective readmission. Conclusions Patients with OUD presented with AMI at a significantly younger age than non-OUD. While OUD appears to have a cardioprotective effect, it is associated with several markers of increased resource use, including readmission. The present findings underscore the need for a multifaceted approach to increasing social services and treatment for OUD at index hospitalization.

7.
Ann Card Anaesth ; 2022 Dec; 25(4): 490-497
Article | IMSEAR | ID: sea-219262

ABSTRACT

Background:Delirium is a commonly seen complication of cardiac surgery. Dexmedetomidine, by its anti?inflammatory properties and other effects, can attenuate postoperative delirium. Aims: The aim of this work was to study the incidence of delirium after coronary artery bypass graft surgery, and to compare the effects of dexmedetomidine and propofol on the incidence of postoperative delirium in coronary artery bypass graft surgery patients. Materials and Methods: A prospective, observational study was conducted on 180 consecutive patients undergoing off?pump or on?pump coronary artery bypass graft surgery. The patients were administered either intravenous dexmedetomidine (n = 90) or propofol (n = 90) after hemostasis was achieved, till they were ready for weaning from the ventilator. The Confusion Assessment Method was used to assess the incidence of postoperative delirium. Measurements and Main Results: A total of 25 (13.8%) patients developed delirium after coronary artery bypass graft surgery. Sedation with dexmedetomidine was associated with a significantly reduced incidence of postoperative delirium (8.9% v 18.9% propofol, P = 0.049). Subgroup analyses showed reduced incidence of postoperative delirium in off?pump patients compared to on?pump coronary artery bypass graft patients (3.3% vs. 20%, P = 0.009 dexmedetomidine group and 11.6% vs. 33.3%, P = 0.047 propofol group respectively). The mean age of the patients who had delirium was significantly more (64.9 ± 8.1 years vs. 52.5 ± 5.8 years, P = 0.046) compared to those who did not have delirium. Conclusion: Administration of dexmedetomidine?based sedation resulted in the reduced incidence of postoperative delirium compared to propofol?based sedation in patients after coronary artery bypass graft surgery

8.
Rev. colomb. cardiol ; 29(6): 629-639, dic. 2022. tab, graf
Article in Spanish | LILACS-Express | LILACS | ID: biblio-1423793

ABSTRACT

Resumen: Introducción: el compromiso del tronco principal izquierdo no protegido (TPInp) en pacientes con enfermedad arterial coronaria (EAC) conlleva alto riesgo de eventos cardiovasculares. La cirugía de revascularización coronaria (CABG) ha sido el estándar de tratamiento; sin embargo, estudios recientes proponen la intervención coronaria percutánea (PCI) como alternativa. Objetivo: evaluar los desenlaces intrahospitalarios y durante el seguimiento del tratamiento de pacientes con compromiso del TPInp. Método: estudio observacional multicéntrico de cohorte retrospectivo, se evaluaron pacientes con EAC y afección del TPI. Muerte de cualquier causa, infarto de miocardio no fatal, accidente cerebrovascular, reintervención y/o readmisión hospitalaria fueron valorados como un desenlace compuesto e individualmente durante la hospitalizacioì n y el tiempo de seguimiento. Resultados: se incluyeron 82 pacientes, con edad promedio 71 ± 9.9 años; 35 recibieron PCI, 31 CABG y 16 manejo meìdico (MM). La mortalidad intrahospitalaria fue del 16%. En el seguimiento medio de 12.3 meses la tasa de mortalidad fue del 20%, la de reinfarto del 6% y la de readmisioìn hospitalaria del 4%. La tasa de incidencia de muerte para MM fue 5.19 por 10.000 personas/diìa, para PCI de 2.3 por 10.000 personas/diìa y para CABG de 1.06 por 10.000 personas/diìa; en el seguimiento la mortalidad fue mayor en el grupo de PCI (HR: 3.6; IC 95% 1.13-11.9; p = 0.02). La frecuencia cardiaca elevada al ingreso se asocioì con mayor mortalidad (0.05). Conclusión: el compromiso del TPI se asocia con alto riesgo de muerte y se presenta con anatomiìa coronaria compleja.


Abstract: Introduction: involvement of the unprotected left main coronary artery (TPInp) in patients with coronary artery disease (CAD) leads to a high risk of cardiovascular events. Coronary artery bypass grafting (CABG) has been the standard of management; however, recent studies propose percutaneous coronary intervention (PCI) as an alternative treatment. Objective: to evaluate the in-hospital and follow-up outcomes of patients with compromised TPInp. Method: retrospective multicenter observational cohort study, we evaluated patients with CAD and TPI involvement. Death from any cause, nonfatal myocardial infarction, stroke, reoperation, and/or hospital readmission were assessed as a composite endpoint and individually during hospitaliza- tion and follow-up time. Results: 82 patients were included, mean age 71 ± 9.9 years; 35 received PCI, 31 CABG, and 16 medical management (MM). In-hospital mortality was 16%. In the mean follow-up of 12.3 months, mortality was 20%, rein- farction 6% and hospital readmission 4%. The incidence rate of death was 5.19 per 10,000 people/day for MM, 2.3 per 10,000 people/day for PCI, and 1.06 per 10,000 people/day for CABG; at follow-up, mortality was higher in the PCI group (HR 3.6; 95%CI 1.13-11.9; p = 0.02). Elevated heart rate on admission was associated with higher mortality (p < 0.05). Conclusion: TPInp involvement is associated with a high risk of death and presents with complex coronary anatomy.

9.
J Indian Med Assoc ; 2022 Nov; 120(11): 63-68
Article | IMSEAR | ID: sea-216634

ABSTRACT

Dual anti-platelet therapy (DAPT) and statins are recommended by guidelines for the management of cardiovascular diseases (CVDs), even though the duration of treatment is guided by ischemic and bleeding risk. Clopidogrel and aspirin are the most commonly used DAPT in CVDs. Adding a statin to DAPT is helpful in reducing the thrombosis risk. Fixed-dose combination (FDC) therapy in CVD can help to address the factors of convenience, compliance, control, cost, and complication better than free drug combinations. Therefore, the FDC of rosuvastatin (10 mg or 20 mg) + clopidogrel (75 mg) + aspirin (75 mg) is likely to improve compliance in CVD patients, thereby reducing adverse cardiovascular outcomes and cost of treatment. There is lack of awareness on long term benefits of this FDC in Indian patients.

10.
Ann Card Anaesth ; 2022 Sep; 25(3): 335-342
Article | IMSEAR | ID: sea-219234

ABSTRACT

Background:An ideal CO monitor should be noninvasive, cost effective, reproducible, reliable during various physiological states. Limited literature is available regarding the noninvasive CO monitoring in open chest surgeries. Aim: The aim of this study was to compare the CO measurement by Regional Impedance Cardiography (RIC) and Thermodilution (TD) method in patients undergoing off pump coronary artery bypass graft surgery (OPCAB). Settings and Design: We conducted a prospective observational comparative study of CO measurement by the noninvasive RIC method using the NICaSHemodynamicNavigator systemand the gold standardTDmethod using pulmonary artery catheterin patients undergoingOPCAB.Atotal of 150 data pair from the two CO monitoring techniques were taken from 15 patients between 40-70 years at various predefined time intervals of the surgery. Patients and Methods: We have tried to find out the accuracy, precision and cost effectiveness of the newer RIC technique. Mean CO, bias and precision were compared for each pair i.e.TD-CO and RIC-CO as recommended by Bland and Altman.The Sensitivity and specificity of cutoff value to predict change in TD-CO was used to create a Receiver operating characteristic or ROC curve. Results: Mean TD-CO values were around 4.52 ± 1.09 L/min, while mean RIC- CO values were around 4.77± 1.84 L/min. The difference in CO change was found to be statistically not significant (p value 0.667). The bias was small (-0.25). The Bland Altman plot revealed a mean difference of -0.25 litres.The RIC method had a sensitivity of 55.56 % and specificity of 33.33 % in predicting 15% change in CO of TD method and the total diagnostic accuracy was 46.67%. Conclusion: A fair correlation was found between the two techniques. The RIC method may be considered as a promising noninvasive, potentially low cost alternative to the TD technique of hemodynamic measurement.

11.
Ann Card Anaesth ; 2022 Mar; 25(1): 97-99
Article | IMSEAR | ID: sea-219186

ABSTRACT

Persistent poststernotomy pain (PSP) is a well?known entity following cardiac surgery done with midline strenotomy. The severity of pain is usually mild to moderate in the majority of the patients. However, a small percentage of patients develop severe and persistent pain and need aggressive treatment. Our patient, a 63?year?old lady developed chronic severe parasternal pain following coronary artery bypass graft surgery. As multiple medications did not relieve her pain effectively, we did an ultrasound?guided pectoral?intercostal fascial plane block to which she responded with excellent and long?lasting pain relief. This is the first such case report of the use of this novel block technique for treating PSP.

12.
Article in Chinese | WPRIM | ID: wpr-934245

ABSTRACT

Objective:To investigate the potential guiding role of fractional flow reserve(FFR) in surgical revascularization by comparing the relationship between coronary fractional flow reserve(FFR) and blood flow pattern status of bypass graft.Methods:A total of 86 patients with coronary artery disease between March 2016 to October 2019 were included in the study, with 59 males and 27 females; the age ranged from 42 to 77 years old, with an average of(58±12) years old. According to the measured FFR value of the left anterior descending artery, they were divided into severe ischemic group(FFR<0.75), boundary group(0.75≤FFR<0.80) and mild ischemic group(FFR≥0.80). Transit time flow meter(TTFM) was used to evaluate the blood flow status of the bridge vessel from the left internal thoracic artery to the left anterior descending coronary artery.Results:Mean graft flow(MGF) was measured at(21.24±5.71)ml/min, (18.25±7.72)ml/min, (16.47±7.83)ml/min in severe ischemic group, boundary group and mild ischemic group. The results of mean pulsatility index(PI) was 2.58±0.96, 3.14±1.19 and 3.53±1.34, the ratio of diastolic flow during the entire graft flow was 0.63±0.10, 0.55±0.11 and 0.53±0.11, patients appeared systolic reverse flow was 2 cases(3.6%), 3 cases(18.8%) and 3 cases (20.0%), respectively. There were statistically significant differences in MGF( P=0.027)、PI( P=0.007)、the ratio of DF( P=0.001) and the quantity of patients appeared systolic reverse flow( P=0.027) between the three groups. Conclusion:Due to increasing severity of coronary artery stenosis, MGF and the ratio of diastolic flow increased, and there appears to be an decreased PI and quantity of patients appeared systolic reverse flow. The chance of bypass graft occlusion may increase for the near and middle term in mild to moderate functional coronary artery stenosis(FFR≥0.75). For patients with severe functional coronary artery stenosis(FFR<0.75), it can obtain satisfactory flow parameters and ideal clinical outcomes.

13.
Article in Chinese | WPRIM | ID: wpr-958430

ABSTRACT

Objective:To analyze the influence of application of bilateral internal mammary artery(BIMA) with different configurations in coronary artery bypass grafting(CABG).Methods:From January 2018 to December 2020, 82 patients underwent CABG using BIMA were included, with 75 males and 7 females, aged(56.9±9.8) years old. According to the target of coronary artery of BIMA, patients were divided into two groups, 23 patients(group B) who underwent the traditional operation(RIMA to the right coronary artery), and 59 patients(group L) whose RIMA were grafted to the left ventricular arteries. Also the patients were divided into two groups according to the RIMA used either in situ(group I, 57 cases) or free(group F, 25 cases). Compare the grafts flow between groups. The CTA angiography of coronary artery was completed to evaluate the grafts patency before discharge.Results:There was 1 early operative death(1.22%). The mean flow(MF) of RIMA was significantly higher in group B( P=0.013). The pulsatility index(PI) of LIMA was significantly lower and the MF of RIMA and BIMA was higher(all P<0.05), fewer patients with LIMA-MF less than 15 ml/min( P=0.023)in the group I. CTA angiography before discharge showed that only 1 RIMA to right coronary artery was occlusion. Conclusion:It is better to use BIMA in situ in CABG, RIMA used in right coronary artery can receive more satisfactory graft flow. BIMA has good patency in early stage, therefore is the ideal and stable coronary bypass graft.

14.
Rev. bras. cir. cardiovasc ; Rev. bras. cir. cardiovasc;36(1): 25-31, Jan.-Feb. 2021. tab, graf
Article in English | LILACS | ID: biblio-1155792

ABSTRACT

Abstract Introduction: This study aimed to evaluate the effects of coronary collateral circulation (CCC) in patients who had undergone coronary artery bypass grafting (CABG). Methods: A total of 127 patients who had undergone CABG (2011-2013) were enrolled into this study and follow-up was obtained by phone contact. Patients were categorized into two groups according to preoperative CCC using the Rentrop method. Percutaneous coronary intervention (PCI), recurrent myocardial infarction (MI), stroke, heart failure (HF), and mortality rates were compared between groups. Clinical outcome was defined as combined end point including death, PCI, recurrent MI, stroke, and HF. Results: Sixty-two of 127 patients had poor CCC and 65 had good CCC. There were no differences in terms of PCI, recurrent MI, and HF between the groups. Stroke (seven of 62 [11.3%] and one of 65 [1.5%], P=0.026) and mortality (19 of 62 [30.6%] and 10 of 65 [15.4%], P=0.033) rates were significantly higher in poor CCC group than in good CCC group. In Kaplan-Meier analysis, survival time was not statistically different between the groups. Presence of poor CCC resulted in a significantly higher combined end point incidence (P=0.011). Conclusion: Stroke, mortality rates, and combined end point incidence were significantly higher in poor CCC patients than in the good CCC group.


Subject(s)
Humans , Coronary Artery Disease/surgery , Stroke/etiology , Percutaneous Coronary Intervention , Coronary Artery Bypass , Treatment Outcome , Collateral Circulation , Coronary Circulation
15.
Article in Chinese | WPRIM | ID: wpr-934203

ABSTRACT

Objective:To study the association between high-normal thyroid-stimulating hormone(TSH) and new onset postoperative atrial fibrillation(POAF) after off-pump coronary artery bypass graft(OPCABG).Methods:Between July 2017 and January 2019, a total of 219 patients who underwent OPCABG in Beijing Chaoyang Hospital were retrospectively analyzed. The patients were divided into two groups, POAF group(64 cases) and non-POAF group(155 cases), in accordance with the occurrence of POAF. POAF was compared across groups with TSH quartile groups with euthyroidism. The perioperative clinical parameters of the two groups were analyzed by univariate analysis. Then, statistically significant factors in the univariate analysis were subjected to multivariate logistic regression analysis to determine if it was an independent risk factor for POAF. Results:Compared with TSH Q4 and TSH Q1- Q3, the incidence of POAF was statistically different( P=0.008). Logistic regression analysis showed that age≥60 years( OR=2.672, P=0.010), HCY≥18 μmol/L( OR=1.956, P=0.039), and high-normal thyroid-stimulating hormone( OR=2.856, P=0.036) were the independent risk factors of POAF after OPCABG. Conclusion:High-normal thyroid-stimulating hormone is the independent risk factor of POAF after OPCABG.

16.
Article in Chinese | WPRIM | ID: wpr-873623

ABSTRACT

@#Objective    To investigate the safety and effectiveness of the multi-artery graf tstrategy for coronary bypass (MICS-CABG) with small incision in the left chest, and to provide experience for the promotion of this technique. Methods    The clinical data of 64 patients with MICS-CABG in Department of Cardiac Surgery of Peking University Third Hospital from December 2015 to November 2019 were retrospectively analyzed. There were 54 males and 10 females, aged 36-77 (61.1±8.7) years. The left lateral thoracic incision (5-8 cm) was made through the 5th intercostal incision, and the operation was performed under off-pump CABG. With the help of the chest wall suspension device and the heart fixator, the proximal anastomosis of the ascending aorta, anastomosis of the target vessels of the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) systems were completed. The number of grafts was 2-4 (2.3±0.5) including 2 grafts in 45 patients, 3 grafts in 17 patients and 4 grafts in 2 patients. Three patients were treated with percutaneous intervention (PCI) hybridization and 62 patients were treated with total artery bypass graft. Coronary angiography was performed within 7 days after the operation to evaluate the graft patency rate. The incidence of major adverse cardiac and cerebrovascular events (MACCE) was recorded in the follow-up. The MACCE rate was calculated by Kaplan-Meier method. Results    None of the patients was transferred to thoracotomy and no intra-aortic balloon counterpulsation (IABP) or extracorporeal membrane oxygenation (ECMO) was used during the operation.  Incision infection was in 1 patient and reoperation in 2 patients (all were postoperative hemorrhage). Within 30 days after surgery, MACCE occurred in 1 patient, including 1 patient of non-fatal myocardial infarction. The overall patency rate of angiography bypass was 96.2%, and the patency rate of anterior descending branch bypass was 98.2%. Follow-up was performed from 12 to 60 months (median follow-up time was 28 months). The loss rate was 7.8% (5/64). The incidence of MACCE was 84.9% (95%CI 79.5%-90.3%). Conclusion    The MICS-CABG can achieve completed re-vascularization and totally artery-CABG and the short-term and medium-term clinical results of the operation are good.

17.
Acta Medica Philippina ; : 41-46, 2021.
Article in English | WPRIM | ID: wpr-877143

ABSTRACT

@#Objective. The study evaluates the clinical profile of patients who underwent coronary artery bypass graft surgery (CABG) under the Philippine Health Insurance Corporation (Philhealth) Z Benefit Package (PZBP), as well as time intervals between PZBP screening, approval, and timing of surgery. Methods. A review of medical records was done to collect data on time intervals between the screening process and Philhealth approval in CABG patients under PZBP. The clinical profile and surgical outcomes of patients were also evaluated. Results. Sixty-three patients were included from March 2017 to December 2018. Most patients were under 61-70 years old. Hypertension was the most commonly observed comorbidity. Time intervals were analyzed including identification for surgery to eligibility screening (2–217 days, median 25 days), Philhealth approval (8–266 days, median 20 days), and surgery (9-403 days, median 33 days). Postoperative atrial fibrillation was seen in 22.58%. The most commonly observed complication prolonging hospitalization was pneumonia. Conclusion. This is the first local study which evaluated the timelines of PZBP. Results may be use as basis of follow up study in the future for identification of an acceptable timeline intervals. Several modifiable factors affecting time intervals were identified for further improvement of healthcare services. The leading cause of increase length in hospitalization were HAP and AF.


Subject(s)
Coronary Artery Disease , Vascular Diseases , Vascular Surgical Procedures , National Health Programs
18.
Chin. j. integr. med ; Chin. j. integr. med;(12): 7-15, 2021.
Article in English | WPRIM | ID: wpr-880561

ABSTRACT

OBJECTIVE@#To assess the effect of valerian root extract on the sleep quality of patients after coronary artery bypass graft (CABG) surgery.@*METHODS@#The patients who participated in this triple-blind clinical trial were selected by permuted block randomization. The participants were assigned to the valerian (n=36) and placebo (n=36) groups. The valerian group received 530 mg of valerian capsules for 30 nights after CABG surgery, and the placebo group received 530 mg of the placebo capsules containing wheat flour. The Pittsburgh Sleep Quality Index (PSQI), the prothrombin time (PT) and partial thromboplastin time (PTT) were assessed on four occasions, including the baseline, the 3rd, 14th and 30th days following intervention.@*RESULTS@#The odds ratio of worsened sleep quality significantly varied over time (the interaction of time and group) in the valerian group compared to the placebo group in various dimensions including total sleep quality (P=0.001), sleep latency (P<0.01), sleep duration (P=0.020), sleep efficiency (P=0.001) and daytime dysfunction (P=0.025). No significant difference was observed in the alterations of the odds ratio of PT in the two groups over time. (P=0.371).@*CONCLUSION@#The consumption of oral valerian root extract over 30 nights could significantly improve the patients' sleep quality safely after CABG surgery.

19.
Arch. cardiol. Méx ; Arch. cardiol. Méx;90(4): 467-474, Oct.-Dec. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1152821

ABSTRACT

Resumen Objetivo: Comparar las tasas de recurrencia de revascularización coronaria (cirugía o intervención coronaria percutánea), nuevo evento isquémico o muerte en pacientes con puentes secuenciales y con puentes simples. Método: Cohortes ambispectivas de pacientes sometidos a cirugía de revascularización coronaria secuencial (n = 111) o simple (n = 145) entre el 1 de enero de 2013 y el 31 de diciembre de 2017. Pacientes mayores de 18 años en un primer procedimiento de revascularización, con circulación extracorpórea. Para el seguimiento se realizó revisión del expediente o comunicación telefónica hasta el 9 de febrero de 2019. Se investigaron los siguientes desenlaces: reintervención por isquemia coronaria, nuevo evento isquémico documentado o muerte atribuida a cardiopatía isquémica; también se obtuvieron curvas de sobrevida. Resultados: La proporción de recurrencia según la técnica quirúrgica no fue estadísticamente diferente: secuencial 6.5% (intervalo de confianza del 95% [IC95%]: 2.6-12.6%) contra simple 4.8% (IC95%: 2-9.7%; p = 0.60; análisis bayesiano BF10 = 0.37; evidencia moderada a no diferencia), todos por nuevo evento isquémico y un fallecimiento por grupo. No hubo diferencias en el tiempo de seguimiento: secuencial 59 meses (IC95%: 56-62) y simple 66 meses (IC95%: 64-68). No encontramos diferencia en las tasas de incidencia de recurrencia: secuencial 1.99 eventos/103 meses-paciente contra simple 1.47 (hazard ratio: 1.34; IC95%: 0.47-3.8; p = 0.58). El tiempo promedio de pinzamiento y de circulación extracorpórea por puente fue menor en el grupo de puentes combinados (41.44 minutos de circulación extracorpórea y 24.69 minutos de pinzamiento/puente) que en el de puentes simples (43 minutos en circulación extracorpórea y 26.4 minutos de pinzamiento/puente) cuando se ajusta al promedio de puentes colocados (simples 2.7 y secuencial 3.25; p < 0.001); sin embargo, no se encontró significancia estadística (p = 0.7). Conclusión: Ambos procedimientos tuvieron una baja incidencia de recurrencia de eventos clínicos, sin diferencias entre las técnicas quirúrgicas.


Abstract Objective: To compare the recurrence rates of revascularization (redo CABG or PCI), new ischemic event or death in patients with simple grafts and patients with sequential grafts. Method: Study design is an ambispective cohort of patients that underwent CABG by sequential grafting (n = 111) or simple grafting (n = 145) between January 1st, 2013 and December 31st, 2017. Patients had to be 18 years old at the time of surgery, undergoing their first on-pump CABG. The clinical record of every patient was carefully reviewed and patients who had incomplete follow-up in external consultation were contacted by telephone in order to obtain data about ischemia related reintervention (CABG or PCI), new documented ischemic event or death caused by coronary artery disease, Kaplan-Meier estimators were calculated. Results: The proportion of recurrence depending on technique was not statistically different: sequential (6.5% [CI95% 2.6-12.6%] versus simple 4.8% [CI95% 2-9.7%], p = 0.60, Bayesian analysis BF10 = 0.37; moderate evidence to no difference), each one related to new ischemic event and one death per group. There were no differences in follow-up time (sequential 59m [CI95% 56-62] simple 66m [CI95% 64-68]). No difference was found regarding recurrence incidence rates; sequential 1.99 events x 103 months-patient, versus simple 1.47 (HR=1.34; CI95% 0.47-3.8, p = 0.58). Pump and cross-clamping times were lower for sequential technique (41.44 min; 24.69 min respectively) versus simple technique (43 min; 26.4 min respectively) with a p = 0.7 after adjusting to mean grafts per surgery (2.7 simple; 3.25 sequential, p < 0.001). Conclusions: Both techniques had a low incidence of clinical recurrence, without significant differences between procedures.


Subject(s)
Humans , Middle Aged , Coronary Artery Bypass/methods , Myocardial Ischemia/surgery , Percutaneous Coronary Intervention/methods , Myocardial Revascularization/methods , Recurrence , Cohort Studies , Follow-Up Studies , Bayes Theorem
20.
Rev. chil. cardiol ; 39(3): 273-279, dic. 2020. ilus, tab
Article in Spanish | LILACS | ID: biblio-1388066

ABSTRACT

Resumen: La revascularización coronaria híbrida busca combinar el beneficio de las técnicas quirúrgicas y percutáneas para un manejo óptimo de pacientes seleccionados con enfermedad coronaria obstructiva multivaso. Esto permite asociar el beneficio del puente de arteria mamaria interna izquierda a la arteria descendente anterior (ADA) y combinarlo con el implante de stents en lesiones no-ADA. El objetivo de este trabajo es hacer una revisión de la literatura disponible con énfasis en sus resultados clínicos comparados con la estrategia convencional.


Abstract: Hybrid coronary revascularization seeks to combine the benefit of surgical and percutaneous techniques for optimal management of selected patients with multivessel coronary artery disease. This allows combining the benefit of the left internal mammary artery bypass to the anterior descending artery (LAD) and stent deployment in non-LAD lesions. The objective of this manuscript is to review the available literature with emphasis on its clinical results compared to the conventional strategy.


Subject(s)
Humans , Coronary Artery Disease/surgery , Coronary Artery Bypass/methods , Percutaneous Coronary Intervention/methods , Minimally Invasive Surgical Procedures
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